Selective Outpatient Management of Upper Gastrointestinal Bleeding in The Elderly

Cebollero-Santamaria, Francisco; Smith, James W.; Gioe, Scott M.; Frank, Timothy Van; Call, Ricardo Mc; Airhart, Joanne; Perrillo, Robert P.

doi:10.1111/j.1572-0241.1999.01073.x

Cited by 46 publications

(22 citation statements)

References 10 publications

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“…The percentage of deaths related directly to bleeding was generally low even in the very elderly, and the majority of elderly patients with AUGIB died of unpreventable causes. Stable elderly patients with AUGIB and no significant co-morbid illnesses and low risk endoscopic findings can even be managed safely as outpatients, as reported in a previous study [32] .…”

Section: Discussionsupporting

confidence: 64%

Acute upper gastrointestinal bleeding in octοgenarians: Clinical outcome and factors related to mortality

Theocharis¹,

Arvaniti²,

Assimakopoulos³

et al. 2008

WJG

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AIM:To evaluate the aetiology, clinical outcome and factors related to mortality of acute upper gastrointestinal bleeding (AUGIB) in octogenarians. METHODS:We reviewed the records of all patients over 65 years old who were hospitalised with AUGIB in two hospitals from January 2006 to December of 2006. Patients were divided into two groups: Group A (65-80 years old) and Group B (> 80 years old). RESULTS: Fo u r h u n d re d a n d s i x t e e n p a t i e n t s over 65 years of age were hospitalized because of AUGIB. Group A included 269 patients and Group B 147 patients. Co-morbidity was more common in octogenarians (P = 0.04). The main cause of bleeding was peptic ulcer in both groups. Rebleeding and emergency surgery were uncommon in octogenarians and not different from those in younger patients. In-hospital complications were more common in octogenarians (P = 0.05) and more patients died in the group of octogenarians compared to the younger age group (P = 0.02). Inability to perform endoscopic examination (P = 0.002), presence of high risk for rebleeding stigmata (P = 0.004), urea on admission (P = 0.036), rebleeding (P = 0.004) and presence of severe co-morbidity (P < 0.0001) were related to mortality. In multivariate analysis, only the presence of severe co-morbidity was independently related to mortality (P = 0.032). CONCLUSION: While rebleeding and emergency surgery rates are relatively low in octogenarians with AUGIB, the presence of severe co-morbidity is the main factor of adverse outcome.

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Section: Discussionsupporting

confidence: 64%

Acute upper gastrointestinal bleeding in octοgenarians: Clinical outcome and factors related to mortality

Theocharis¹,

Arvaniti²,

Assimakopoulos³

et al. 2008

WJG

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“…Three prospective studies (performed in the USA and the UK) reported that NSAID use increased the risk of rebleeding [43,44,45]. However, a fourth prospective study set in Sweden found that admission due to ASA or NSAID-associated ulcer bleeding was associated with a significantly lower risk of rebleeding (OR: 0.53; 95% CI: 0.28–0.95) [46], perhaps because ASA or NSAIDs were discontinued after the initial bleed.…”

Section: Resultsmentioning

confidence: 99%

Systematic Review of the Epidemiology of Complicated Peptic Ulcer Disease: Incidence, Recurrence, Risk Factors and Mortality

Lau

Sung²,

Hill³

et al. 2011

Digestion

460

334

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Background/Aims: The incidence of uncomplicated peptic ulcer has decreased in recent years. It is unclear what the impact of this has been on the epidemiology of peptic ulcer complications. This systematic review aimed to determine the incidence, recurrence and mortality of complicated peptic ulcer and the risk factors associated with these events. Methods: Systematic PubMed searches. Results: Overall, 93 studies were identified. Annual incidence estimates of peptic ulcer hemorrhage and perforation were 19.4–57.0 and 3.8–14 per 100,000 individuals, respectively. The average 7-day recurrence of hemorrhage was 13.9% (95% CI: 8.4–19.4), and the average long-term recurrence of perforation was 12.2% (95% CI: 2.5–21.9). Risk factors for peptic ulcer complications and their recurrence included nonsteroidal anti-inflammatory drug and/or acetylsalicylic acid use, Helicobacter pylori infection and ulcer size ≧1 cm. Proton pump inhibitor use reduced the risk of peptic ulcer hemorrhage. Average 30-day mortality was 8.6% (95% CI: 5.8–11.4) after hemorrhage and 23.5% (95% CI: 15.5–31.0) after perforation. Older age, comorbidity, shock and delayed treatment were associated with increased mortality. Conclusions: Complicated peptic ulcer remains a substantial healthcare problem which places patients at a high risk of recurrent complications and death.

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“…Patients were selected for outpatient care by a combination of both clinical and endoscopic criteria in all studies. Two studies 32,36 excluded potential variceal hemorrhage before endoscopic confirmation by selecting out subjects with evidence of alcoholic liver disease. One study excluded from enrollment patients taking noncorticosteroidal antiinflammatory drugs.…”

Section: Brullet Et Almentioning

confidence: 99%

“…Cebollero-Santamaria et al 32 evaluatedaprotocolinwhichclinically low-risk elderly (age Ն65 years) patients were discharged after immediate endoscopic confirmation in the emergency department. Those with a low risk for rebleeding, as determined by explicit endoscopic and clinical criteria, were discharged and followed up intermittently for 1 month.…”

Section: Brullet Et Almentioning

confidence: 99%

Endoscopy for Acute Nonvariceal Upper Gastrointestinal Tract Hemorrhage: Is Sooner Better?

Spiegel¹,

Vakil²,

Ofman³

2001

Arch Intern Med

180

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The overwhelming majority of existing data suggest that early endoscopy is safe and effective for all risk groups. The clinical and economic outcomes of early endoscopy should be confirmed in additional well-designed randomized controlled trials. Given the strength of the evidence, efforts to develop a more standardized and time-sensitive approach to acute nonvariceal upper gastrointestinal tract hemorrhage should be undertaken.

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Selective Outpatient Management of Upper Gastrointestinal Bleeding in The Elderly

Cited by 46 publications

References 10 publications

Acute upper gastrointestinal bleeding in octοgenarians: Clinical outcome and factors related to mortality

Acute upper gastrointestinal bleeding in octοgenarians: Clinical outcome and factors related to mortality

Systematic Review of the Epidemiology of Complicated Peptic Ulcer Disease: Incidence, Recurrence, Risk Factors and Mortality

Endoscopy for Acute Nonvariceal Upper Gastrointestinal Tract Hemorrhage: Is Sooner Better?

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